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Anxiety disorders and their clinical correlates in multiple sclerosis patients

Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5

A Feinstein

Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; antfeinstein{at}aol.com

Objective To assess prevalence rates and clinical correlates of anxiety disorders in patients with multiple sclerosis (MS).

Methods Demographic and neurological data were collected on 140 consecutive clinic attendees, and their lifetime and point prevalences of anxiety disorders were determined with the Structured Clinical Interview for DSM-IV disorders (SCID-IV). All subjects completed the self-report Hospital Anxiety and Depression Scale (HADS). Suicidal intent was rated with the Beck Suicide Scale (BSS), psychosocial stressors and supports were quantified with Social Stress and Support Interview (SSSI), and cognition assessed with Neuropsychological Screening Battery for MS.

Results The lifetime prevalence of any anxiety disorder was 35.7%, with panic disorder (10%), obsessive compulsive disorder (8.6%), and generalized anxiety disorder (18.6%), the most common diagnoses obtained. Subjects with an anxiety disorder were more likely to be female, have a history of depression, drink to excess, report higher social stress and have contemplated suicide. The diagnosis of an anxiety disorder had been missed in the majority of subjects, therefore, they had not received treatment. A discriminant function analysis identified a series of variables that correctly classified 75% of patients with an anxiety disorder.

Conclusion Anxiety disorders are common in patients with MS, but are frequently overlooked and under-treated. Risk factors include being female, a co-morbid diagnosis of depression, and limited social support. Clinicians should evaluate all MS subjects for anxiety disorders, as they represent a treatable cause of disability in MS.

Key Words: anxiety • anxiety disorders • depression • multiple sclerosis • prevalence • psychiatry

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